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Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study.
BMC Geriatr 2019; 19(1):359BG

Abstract

BACKGROUND

The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management.

METHODS

Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs.

RESULTS

We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care.

CONCLUSIONS

We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.

Authors+Show Affiliations

Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. kai.sprengel@usz.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31856739

Citation

Peterer, Lorenz, et al. "Implementation of New Standard Operating Procedures for Geriatric Trauma Patients With Multiple Injuries: a Single Level I Trauma Centre Study." BMC Geriatrics, vol. 19, no. 1, 2019, p. 359.
Peterer L, Ossendorf C, Jensen KO, et al. Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. BMC Geriatr. 2019;19(1):359.
Peterer, L., Ossendorf, C., Jensen, K. O., Osterhoff, G., Mica, L., Seifert, B., ... Sprengel, K. (2019). Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. BMC Geriatrics, 19(1), p. 359. doi:10.1186/s12877-019-1380-z.
Peterer L, et al. Implementation of New Standard Operating Procedures for Geriatric Trauma Patients With Multiple Injuries: a Single Level I Trauma Centre Study. BMC Geriatr. 2019 Dec 19;19(1):359. PubMed PMID: 31856739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of new standard operating procedures for geriatric trauma patients with multiple injuries: a single level I trauma centre study. AU - Peterer,Lorenz, AU - Ossendorf,Christian, AU - Jensen,Kai Oliver, AU - Osterhoff,Georg, AU - Mica,Ladislav, AU - Seifert,Burkhardt, AU - Werner,Clément M L, AU - Simmen,Hans-Peter, AU - Pape,Hans-Christoph, AU - Sprengel,Kai, Y1 - 2019/12/19/ PY - 2017/11/12/received PY - 2019/12/10/accepted PY - 2019/12/21/entrez PY - 2019/12/21/pubmed PY - 2019/12/21/medline KW - Algorithm KW - Geriatrics KW - In-hospital mortality KW - Multiple trauma KW - Standard of care SP - 359 EP - 359 JF - BMC geriatrics JO - BMC Geriatr VL - 19 IS - 1 N2 - BACKGROUND: The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management. METHODS: Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs. RESULTS: We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care. CONCLUSIONS: We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit. TRIAL REGISTRATION: Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/31856739/Implementation_of_new_standard_operating_procedures_for_geriatric_trauma_patients_with_multiple_injuries:_a_single_level_I_trauma_centre_study L2 - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1380-z DB - PRIME DP - Unbound Medicine ER -